<< Back to the abstract archive
Timing of Supraglottoplasty for Laryngomalacia in the Treatment of Robin Sequence
S. Travis Greathouse, MD; Christopher M. Runyan, MD, PhD; Bruce H. Matt, MD MS,; Stacey L. Ishman, MD, MPH; Christopher B. Gordon; Brian S. Pan, MD; Sunil Tholpady, MD, PhD
Indiana University School of Medicine
2015-03-14
Presenter: S. Travis Greathouse
Affidavit:
The fellow is responsible for 70% of the original work
Director Name: Sunil Tholpady
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction: Mandibular distraction has become a common surgical treatment for isolated Robin Sequence (RS). It has been described that the presence of laryngomalacia, the most common pediatric airway disease, should not bias the management of RS towards tracheotomy. In this study two institutional protocols are compared to determine the optimal management of RS-associated laryngomalacia.
Methods: A ten year (2004-2013) retrospective review of all infants under six months with RS who underwent MDO while diagnosed with laryngomalacia at two children's hospitals was performed. Protocols were similar with regard to indications for MDO but differed in the management of associated laryngomalacia. At institution one supraglottoplasty was performed at the time of MDO (if necessary), whereas at institution two laryngomalacia was expectantly managed until the time of palate repair. Outcomes including need for supraglottoplasty and decrease in AHI were compared.
Results: Eight and 6 infants from institutions one and two respectively met inclusion criteria. No patients were preoperatively intubated, 88 vs 83% had a late surgical intervention, and 38 vs 33% had a syndromic diagnosis. Patients were similar with regard to preoperative demographics. There was no difference in rate of supraglottoplasty in the early cohort compared to those that waited (63 vs 33%; p = 0.09). The improvement in AHI was similar in those that had early supraglottoplasty with those where supraglottoplasty was deferred.
Conclusions: RS complicated by laryngomalacia acts synergistically to derail normal aerodigestive function. There is no significant difference in AHI if supraglottoplasty is deferred until later in the treatment algorithm.
